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7262 MS Block 1 > Fleming chronic pain > Flashcards

Fleming chronic pain Flashcards

1
Q

Do not dose over __ morphine equivalents (MME)

A

90

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2
Q

Use caution dosing over __ morphine equivalents (MME)

A

50

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3
Q

Reassess meds at least every __ months

A

3

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4
Q

Chronic pain dosing start with what?

A

PRN short acting opioid

add long acting opioid in dose equal to 50-75% of 24 hour PRN dose

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5
Q

An alternative for uncontrolled pain on current dosing is to increase long acting med by __ to __ %

A

15, 25

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6
Q

Ensure pain meds are stable for __ hours if discharging from acute setting with pain meds

A

24

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7
Q

Do opioids have a ceiling effect?

A

no

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8
Q

What is first line for osteoarthritis pain?

A

acetaminophen

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9
Q

What nsaid is preferred in the elderly?

A

acetaminophen

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10
Q

2 drug classes for adjuvant cancer pain?

A

steroids

bisphosphonates

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11
Q

4 first line agents for neuropathic pain?

A

gabapentin
amitriptyline
duloxetine
pregabalin

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12
Q

5 second line agents for neuropathic pain?

A 
tramadol
APAP/nsaids
opioids
topiramate
oxcarbazepine
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13
Q

2 TCAs used as pain adjuvant Tx?

A

amitriptyline

nortriptyline

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14
Q

2 SNRIs used as pain adjuvant Tx?

A

duloxetine

venlafaxine

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15
Q

Which adjuvant SNRI is also labeled for chronic musculoskeletal pain?

A

duloxetine

fibromyalgia

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16
Q

4 anticonvulsants used for adjuvant pain?

A

gabapenin
pregabalin
oxcarbazepine
carbamazepine

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17
Q

Opioids are __ line for neuropathic pain.

a. first
b. second

A

b. second

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18
Q

What opioid is used for neuropathic pain rescue therapy?

A

tramadol

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19
Q

Do muscle relaxants have addiction potential?

A

yes

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20
Q

Muscle relaxants are preferred for __ use only

a. short
b. long

A

a. short

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21
Q

What muscle relaxant is also available in IV form?

A

methocarbamol

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22
Q

What muscle relaxant’s absorption is increased by food?

A

metaxalone

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23
Q

4 muscle relaxants:

A

cyclobenzaprine (Flexeril)
carisoprodol (Soma)
methocarbamol (Robin)
metaxalone (Skelaxin)

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24
Q

two alpha2 adrenergic agonists for pain?

A

clonidine

tizanidine

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25
Q

Which alpha 2 adrenergic agonist is used for postoperative or cancer pain, with a possible role in chronic pain or neuropathy?

A

clonidine

0.1mg BID

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26
Q

Which alpha 2 adrenergic agonist is used for pain/discomfort due to spasticity?

A

tizanidine

2mg TID

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27
Q

__ is a NMDA receptor antagonist that is typically used for anesthesia/sedation in the critical care setting

A

ketamine

lower doses can be used for pain

28
Q

What control class is ketamine?

A

C-III

29
Q

The best evidence for adjuvant agents is for __ pain

A

neuropathic

30
Q

__ is the therapeutic effect of a med proportionate to the unit strength or volume. In the case of pain management, the ratio of doses or med required to provide an equivalent pain relief

A

potency

31
Q

__ is the dose at which two different pain meds provide an approximate equivalent pain relief

A

equianalgesic dose

32
Q

Will sedation and n/v decrease over time with opioids?

A

yes

33
Q

2 weak full agonists?

A

codeine

hydrocodone

34
Q

2 agents with most histamine release?

A

morphine

codeine

35
Q

Is buprenorphine synthetic or semi-synthetic?

A

semi-synthetic

36
Q

Which opioid has accumulation of active metabolites in renal insufficiency causing agitation, confusion, delirium?

A

morphine

37
Q

Which opioid is dose reduced in renal dysfunction due to drug accumulation?

A

hydromorphone

38
Q

Which opioid has an ER formulation for pts needing continuous management of mod to severe pain?

A

oxycodone

39
Q

___ ER is approved as a stand alone formulation available through REMS program only

A

Zohydro

form of hydrocodone

40
Q

Which opioid has BBW for respiratory depression and death in children following tonsillectomy in ultra rapid metabolizers?

A

codeine

41
Q

Which opioid should generally not be used in opioid naive pts?

A

fentanyl

42
Q

Which form of fentanyl is never used for acute pain?

A

patch

43
Q

Should fentanyl dose be titrated up in the setting of acute pain?

A

no

44
Q

Does fentanyl have serotonergic actions?

A

yes

caution wit MAOIs and other serotonergic drugs

45
Q

Which opioid has less effects on BP than others?

A

fentanyl

46
Q

Which opioid is 5-10 times more potent than fentanyl and is used for IV surgical analgesia?

A

sufentanil

47
Q

Which opioid has a new sublingual formulation for use in medically supervised settings?

A

sufentanil

REMS program

48
Q

What opioid is effective treatment for shivering?

A

meperidine

49
Q

Which opioid metabolite can induce hyperpyrexia and/or seizures when used with MAOIs?

A

normeperidine

50
Q

Is meperidine more or less potent than morphine?

A

less potent

shorter duration and greater toxicity

51
Q

Which opioid is a new injection formulation?

A

oliceridine

potential for QT prolongation

52
Q

Avoid methadone dose titrations more frequently than every __ to __ weeks

A

1, 2

caution with QT prolonging agents

53
Q

Which opioid has IV form d/c as of April 2018?

A

pentazocine

54
Q

Common AEs of pentazocine include __ and _

A

hallucination, dysphoria

55
Q

Is pentazocine a full or partial agonist?

A

partial

PO combo product with naloxone to deter misuse

56
Q

What control class is tramadol?

A

C-IV

57
Q

Tramadol should be used with caution in pts with __ disorders

A

seizure

58
Q

Two centrally acting alternate agents?

A

tramadol

tapentadol

59
Q

What control class is tapentadol?

A

C-II

60
Q

Which centrally acting alternate agetn is used for neuropathy?

A

tapentanol

61
Q

Pts taking oral morphine __mg daily for >= 1 week are at risk of tolerance?

A

60

62
Q

Pts taking transdermal fentanyl __ mcg/h for >= 1 week are at risk of tolerance?

A

25

63
Q

Pts taking oral oxycodone __mg daily for >= 1 week are at risk of tolerance?

A

30

64
Q

Pts taking oral hydromorphone __mg daily for >= 1 week are at risk of tolerance?

A

8

65
Q

Pts taking oral oxymorphone __mg daily for >= 1 week are at risk of tolerance?

A

25

66
Q

When accounting for incomplete cross tolerance reduce equianalgesic dose of new drug by __ to __ %

A

25, 50

67
Q

A pt tolerant to the effect and side effects of one opioid may not be equally tolerant to the effects and side effects of another opioid

a. true
b. false

A

a. true

7262 MS Block 1 (11 decks)

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